Studies on the Water Metabolism in Diabetes Mellitus

Abstract

Dilution test:
No remarkable difference between normal individuals and the patients of Type I was observed. The amount of urine output was approximately 1000 c. c., the specific gravity gradually decreased and the body weight was invariable or slightly lost.
On the contrary, in Type II there were no striking increase of output and fall of specific gravity except 2 cases.
The results of the above experiment correspond to that of Klein, ¹⁶⁾ Gerbi¹⁹⁾ and Ralli.²⁰⁾
Moreover, it is interesting that the same results were obtained in the experiment performed without giving water; and it is assumed that in severe cases of diabetes the water intake has no influence upon the urine output and the fluid taken is stored in the body.
After recovery from diabetic symptoms by the suitable treatment, the urine output increased in every case, especially remarkable in severe cases notwithstanding the total daily amount becoming small, although we found no great difference in comparison with the results before the treatment when there was no recovery.
Concentration test:
In every case the rise of specific gravity was observed, while in Type II it is so high previously as a rule that it was not so marked.
The amount of urine is comparatively small in Type I.
As Kailhack²¹⁾ described, we found, out a close relation between the amount of urine output and urine sugar, that is, when the former was large the latter was simillarly large and we noticed the decrease of the former together with that of the latter after recovery with the diabetic treatment.
Discussion:
As many authors stated, no established theory on the disturbance of water metabolism has been found.
They thought to find out the causal meaning in the disturbances of kidney function caused by glycosuria, ²²⁾ in diabetic aeidosis, ³⁾⁶⁾ in the failure of the intermediary water metabolism in the tissues, ¹⁵⁾ in saline action, ²³⁾ in the insufficiency of nutrition of capillary wall due to the disturbance of carbohydrate assimilating process⁷⁾ and in hypophysis.²⁴⁾
In severe stage of diabetes, there occurs the profound dehydration from the excessive loss of water, and it is easily assumed that in the dilution test done under this condition the administrated water is stored in the body, and that by the administration of bread this stored fluid is excreted in a large quantity of urine which goes in parallel with the rise of blood sugar and the increase of urine sugar.
After all, severe diabetic patients have a tendency to store the fluid in the body cells preparing for excretion of an increased urine sugar following hyperglycemia.
If they take the food which causes hyperglycemia without taking the water sufficiently, the occurence of dehydration, clinically thirst and desiccation of the skin are observed.
On the contrary if they take the water sufficiently and the food res-trictedly, the fluid is stored and clinically edema occurs.
In severe diabetic cases, as Nakagawa⁹⁾ reported, it is easily under-stood that we see frequently the occurence of edema in such cases as the restricted diet is given; while Stolte⁸⁾ said diabetic edema is due to cachexia caused by the excessive limitted diet, therefore, the food must be given sufficiently; although this is different from our opinion theoretically, we can easily endorse it.
Further, it is understood from these facts that it is seldom to see dia-betic edema under the dietary management of our Clinic, containing 250-350 grins. of carbohydrate, 80-100 grins. of protein, 30-40 grms. of fat and about 1600-2200 calories.